Introduction Managing severe hip arthritis associated with complex femoral deformity and malalignment is challenging. Deformity can arise secondary to congenital conditions, such as Dysplasia, Perthes and SUFE as well as after trauma. Variable degrees of shortening, malalignment and malrotation can present on the femoral side, often associated with acetabular deficiencies that further complicate THA. Both having potentially adverse effects on clinical outcome. Materials, Methods and Results We review our experience using custom designed femoral components (Symbios). We report clinical and radiological outcomes of 35 patients, (15 males and 20 females), with a mean age of 46 (range 21–79), undergoing custom THA, between 2014 and 2025 at our institution. Primary diagnosis was Congenital Hip Dysplasia (58%), Perthes (19%), Trauma (13%), SUFE (10%). Average follow up was 35months (range 6 –134mths). 97% of the components were uncemented. The process of CT based planning in collaboration with design engineers, to produce the custom stems is demonstrated. Our ability to deliver our planned optimised biomechanics is evaluated with an independent radiological review of pre and post op radiographs. Clinical outcomes with revision rates, additional procedures, length of stay and PROMS are reported with a description of complications. Our results showed 100% survivorship of the Symbios stems, with one acute acetabular revision for instability. There were no infections in this small but complex series of patients, with no nerve injuries and no clinically relevant component subsidence. Discussion Our clinical and radiological outcomes in this young, active yet complex group of THA patients are reassuring. Our study demonstrates that with careful planning and accurate surgery, good medium-term outcomes can be achieved. Our ability to deliver planned improved biomechanics, with durable fixation and modern bearings, provides confidence that encouraging medium term outcomes will convert to good longer term survivorship in this complex group.
Manktelow et al. (Thu,) studied this question.